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UTHealth hosts first critical care class for nurses and paramedics

Chivas Guillote, B.S.N.

HOUSTON – (July 10, 2013) – A recent intensive two-week course on critical care hosted by the Department of Emergency Medicine at The University of Texas Health Science Center at Houston (UTHealth) Medical School drew students from Afghanistan, Saudi Arabia, Alaska and Utah.

In other words, they weren’t your typical crop of nurses and paramedics and it wasn’t a typical course. In fact, it was just the first time the Emergency Medicine Critical Care Transport Provider Course had been taught in Houston.

Hosting the course, developed by the University of Maryland, was the brainstorm of Keith Gates, M.D., assistant professor of emergency medicine at UTHealth and Chivas Guillote, BSN, a paramedic who is also a cardiovascular intensive care nurse at Memorial Hermann-Texas Medical Center.

“The basic education for a paramedic encompasses managing the first 30 to 60 minutes of a medical emergency, for example, immediate care of trauma, heart attack or stroke,” said Guillote, who is a graduate of the UTHealth School of Nursing and was the site director for the training. “It doesn’t prepare you for after a patient gets to the hospital, so you’re not trained to manage advanced parameters established by the hospital. This curriculum teaches paramedics the ICU skills required to transport patients. Originally this course was geared toward paramedic providers. Today the course welcomes other disciplines in the health care team interested in critical care transport.”

Among the class members were James McDaniel, a paramedic for Saudi Aramco in Saudi Arabia; John Seydel, who works with drug interdiction forces in Afghanistan as a search and rescue medic; Joe Williams, a paramedic attached to security forces at the United States Embassy in Kabul; Josh Forsythe, a paramedic with the Provo Fire and Rescue in Utah; and Josh Hearn, a paramedic with the Alaska Regional Flight Program. Closer to home were Theresa Jackson, a Cypress Creek EMS paramedic; and Linda Sanderson, a night shift paramedic tech at Methodist Sugar Land, among others.

Seydel said he was taking the course because, “As the Army leaves Afghanistan, we need to do longer transports of critical care patients. We could have a patient up to an hour before we can get him where he needs to be.”

A half day of training in the UTHealth Medical School’s gross anatomy laboratory included learning how to establish emergency airways in patients. It was the perfect opportunity for Gates, a lieutenant in the U.S. Navy Reserve, to share stories about cases encountered in two combat tours in Iraq and Afghanistan and in his experience as the assistant medical director for the Houston Fire Department.

He told the story of a young man who was having an asthma attack and began to experience seizures, locking his jaw. Unable to get an endotracheal tube through the patient’s clenched teeth or through the nasopharynyx as the patient was vomiting, Gates had to perform a cricothyroidotomy, which requires cutting through the cricothyroid membrane. The quick procedure saved the teen’s life, Gates said, before demonstrating how to do it.

“As a medical student when I was in this anatomy lab,” Gates told the students, “I would go and feel every single body to find the cricothyroid cartilage so that it came automatically and I could do it in the dark.”

The students learned the skills necessary to keep critical care patients stable during transfer from one medical institution to another, including managing ventilators, administering blood transfusions, treating sepsis and burns, and managing high-risk pregnancies. They also learned how to insert intravenous lines into bone marrow when blood veins have collapsed and the proper way to perform a needle decompression and finger thoracotomy to let air out of the chest in cases of tension pneumothorax.

“The graduates of this course are highly sought-after commodities because employers who hire our students do not have to spend as much time providing them additional training,” Guillote said.